Daphne Bramham: Are policymakers making BC’s drug crisis worse?

Opinion: There is no evidence that BC’s “safer supply” of drugs for drug addicts outside of a clinical setting is working. Could this make matters worse?

Content of the article

With a pandemic and an epidemic of drug overdoses, Canadian politicians are making life-or-death political decisions that they believe are based on science.

Advertising

Content of the article

Decisions have far-reaching implications and, as Ottawa’s 22-day blockade demonstrated, they are never universally popular.

Harvard professor Bertha Madras briefly made this point when testifying about the science behind British Columbia and Canada’s experiment with a “safe supply” or “safer supply” of drugs.

It started in March 2020 as “risk mitigation drugs” during the COVID-19 pandemic and was expanded in mid-2021 with a three-year commitment of $37.6 million from governments British Columbia and the federal government.

Both admitted that it was unprecedented to provide heroin outside of a clinical setting, let alone amphetamines, benzodiazepines and alcohol.

Still, safe supply advocates are urging the federal government to expand the program nationwide even though Overdose deaths in British Columbia in 2021 rose 26% to a record 2,224 and there was what the BC Center for Disease Control called “an extremely high number of non-fatal events.”

Advertising

Content of the article

“The responsibility you have is serious,” Madras told an Alberta legislative committee set up to review security of supply. “The stakes are very high and the decisions you make can affect generations to come.

“It is indeed an experience with vast and multi-generational implications. It’s also really a human experiment without informed consent because the evidence in terms of randomized controlled trials, meta-analysis reviews sucks.

The psychobiologist was chairman of the 2017 U.S. Presidential Commission on Drug Addiction and the Opioid Crisis and served as “Deputy Drug Czar” during the George W. Bush administration.

She suggested policymakers ask the following questions: Is there evidence that a secure supply will stabilize or decrease the number of people with opioid use disorders? Will a secure supply lead to an increase in drug use? Will people use a secure supply safely? Will it be used as an incentive that gets people into treatment and recovery?

Advertising

Content of the article

Over three days of hearings, his questions were asked and answered. They likely will be again when hearings resume in March, although the answers may be different since the experts invited include key advocates for safe supply.

Guests include: Dr. Perry Kendall, a former health worker from British Columbia; Dr. Mark Tyndall, whose vending machines supply heroin to 70 users; Cheyenne Johnson, executive director of the BC Center on Substance Use; and Eris Nyx of the Drug Users Liberation Front.

SFU’s Julian Somers center for applied research in mental health and addiction reviewed 839 studies on safe supply for the committee as a reference for its members.

None of the studies were based on randomized trials, which are considered the gold standard of scientific research. And, there has been no systematic review of their findings.

Advertising

Content of the article

Eighteen reported original results, 16 of which were performed in Canada. Of the 18, a dozen results were based on interviews with participants and six on questionnaires.

None used objective measures, such as biomarkers in urine, to determine whether participants also used other drugs or used administrative data to determine whether there was a reduction in crime, visits to emergencies or a change in housing status from homeless to housed.

Neglecting these social factors, Somers said, “is an unusual, very contrarian view in the field of addiction (research), where the demand for addiction is massively created by isolation and estrangement from society. “.

Social integration is the principle on which Portugal formulated its wide range of highly successful drug policies more than 20 years ago, which include both harm reduction, decriminalization of personal possession, housing and income support for drug addicts and their families.

Advertising

Content of the article

Portugal’s drug czar, Dr João Goulão, was also asked to testify in March.

“What worries me is that we have made progress in reducing prescriptions and that we could reverse this by prescribing more opioids than we have ever prescribed under a safe supply” , psychiatrist Nickie Mathew told the committee.

Mathew is the Head of Complex Mental Health and Addictions Services for the Provincial Health Services Authority of British Columbia.

Since a safe supply, he and others said the retail price of hydromorphone — the prescription heroin pill — went from $10 to 25 cents.

He and other experts told the committee about an overwhelming number of peer-reviewed studies that have found that whenever addictive substances are more readily available – whether alcohol, tobacco, of cannabis or prescription opioids – consumption and addiction are increasing.

Advertising

Content of the article

Recent studies that examined the massive overprescription of opioids in Canada and the United States in the early 2000s concluded that between 8 and 12% of patients eventually became addicted and that they represented up to 80% of people with opioids. use the mess.

Between March 27 and August 31, 2020, Mathew said “risk mitigating medication” was provided to 2,780 British Columbians.

Of these, 52% were prescribed opioids, 24% were prescribed amphetamines, 20% were prescribed alcohol withdrawal management medications, and 12% were prescribed benzodiazepines.

Ten people died. But the data doesn’t provide any insight into what prescription drugs they were using or what drugs were in their system when they died. Proponents say the 0.4% death rate is proof of the success of the safe supply.

Advertising

Content of the article

But Mathew noted the annual rate was 0.2% in 2017 – the first full year after British Columbia declared overdose deaths a public health emergency.

Rather than assuming that a safe supply keeps users alive, Mathew said it could also be that the diversion of “safe supply” drugs to the streets leads to addiction and even deaths.

Prescriber guidelines allow up to 14 8mg hydromorphone (heroin) tablets per day with prescriptions sufficient to last up to several weeks. For context, the usual amount prescribed for patients recovering from major surgery is 1-2 mg, three times a day for three days.

Mathew also spoke about the faulty assumptions of prescribers. One of his patients, a UBC student, repeatedly overdosed on prescription hydromorphone and ended up in Vancouver General Hospital before being referred to him.

Each time, she was discharged with another prescription for hydromorphone and not Suboxone, an opioid agonist therapeutic drug that relieves cravings.

Is safe supply safe? It will be interesting to hear what advocates have to say when, or if, they testify before the Alberta panel in March.

[email protected]

Twitter: @bramham_daphne


More news, fewer ads, faster loading times: Get unlimited, lightweight access to the Vancouver Sun, The Province, National Post and 13 other Canadian news sites for just $14/month or $140/year. Subscribe now through The Vancouver Sun or The Province.

Advertising

comments

Postmedia is committed to maintaining a lively yet civil discussion forum and encourages all readers to share their views on our articles. Comments can take up to an hour to be moderated before appearing on the site. We ask that you keep your comments relevant and respectful. We have enabled email notifications. You will now receive an email if you receive a reply to your comment, if there is an update to a comment thread you follow, or if a user follows you comments. See our Community Guidelines for more information and details on how to adjust your email settings.

Comments are closed.